Healthcare Provider Details

I. General information

NPI: 1265580898
Provider Name (Legal Business Name): HAWKEYE CLINIC OF LUVERNE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 N FREEMAN AVE
LUVERNE MN
56156-1628
US

IV. Provider business mailing address

102 N FREEMAN AVE
LUVERNE MN
56156-1628
US

V. Phone/Fax

Practice location:
  • Phone: 507-283-2345
  • Fax: 507-283-2346
Mailing address:
  • Phone: 507-283-2345
  • Fax: 507-283-2346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: CHRIS K LOOSBROCK
Title or Position: INSURANCE COORDINATOR
Credential:
Phone: 507-283-2345